Silicone granuloma mimicking Breast Implant Associated Large Cell Lymphoma (BIA-ALCL): a case report

Shepard, Elizabeth; Kamenko, Srdjan; Snir, Olivia L.; Hansen, Juliana E.

doi:10.1080/23320885.2020.1762495

Cited by 6 publications

(5 citation statements)

References 11 publications

(20 reference statements)

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“…Most frequently free silicone infiltrates the adjacent breast tissues and sometimes can mimic breast cancer [ 5 , 6 ]. The second most common place for free silicone migration is regional lymph nodes (axillary lymph nodes), and silicone aggregates in lymph nodes can also mimic malignant processes [ 7 , 8 ]. Occasionally, free silicone travels to distant regions (arm/forearm, thoracic cavity, abdominal wall, legs, back) [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Value of Ultrasound in the Evaluation of the Integrity of Silicone Breast Implants

et al. 2021

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Background and Objective: Breast implant surgery for cosmetic purposes is the most popular plastic surgery and it has been performed for over 100 years. Rupture of silicone gel-filled breast implants usually is asymptomatic and is one of the more dangerous complications due to free silicone migration. The aim of our study was to evaluate the diagnostic value of ultrasound (US) in the evaluation of the integrity of silicone breast implants and identify the main sign of intact and ruptured breast implants. Patients and Methods: In this retrospective study, the medical documentation of women who underwent breast implant surgery and US checkups at Tautrimas Aštrauskas Clinic in Kaunas, Lithuania, during 2015–2020 was analyzed. The patients were divided into two groups: patients with intact and ruptured breast implants. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as well as the signs of implant integrity of US examination were evaluated. Results: In this study, 76 women with bilateral breast implants (n = 152) were reviewed. On a US examination, ruptured implants were found in 41.1% (n = 61) of the cases; of them, 78.7% (n = 48) of the cases had ≥2 US signs of a ruptured implant, and in all these cases, implant rupture was confirmed at surgery. Overall, one US sign of a ruptured implant was found in 21.3% (n = 13) of the cases. Of them, inhomogeneous content in all cases (n = 3) was found in the intact implant group, and an abnormal implant shell was documented more often in the ruptured implant group, not intact one (n = 9, 90% vs. n = 1, 10%). US had a diagnostic accuracy of 94.7%, sensitivity of 98.3%, specificity of 89.2%, PPV of 93.4%, and NPV of 97.1% in the evaluation of implant integrity. Conclusions: Our results show that US is a very reliable alternative in evaluating breast implant integrity and could be the investigation of choice for implant rupture, while MRI could be advocated only in inconclusive cases. Uneven implant shell was found to be the most important US sign of breast implant rupture. Based on the findings, we recommend performing US examination after breast augmentation surgery with silicone gel-filled implants annually.

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Section: Introductionmentioning

confidence: 99%

The Value of Ultrasound in the Evaluation of the Integrity of Silicone Breast Implants

et al. 2021

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“…In the past, there have been a few cases of BIA-ALCL mimicking lesions that were finally diagnosed as late hematoma and silicone granuloma. [ 7 , 8 ] Silicone granuloma almost always occur along with the rupture of implants. Risk factors for such silicone implant rupture include increased patient age, submuscular pocket placement of implants, and prolonged duration of implant placement.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for such silicone implant rupture include increased patient age, submuscular pocket placement of implants, and prolonged duration of implant placement. [ 7 ] Since many of the symptoms and signs of silicone granuloma overlap with that of BIA-ALCL, it should be included for differential diagnosis whenever implant ruptures are present.…”

Section: Discussionmentioning

confidence: 99%

Bilateral late hematomas after breast augmentation mimicking anaplastic large cell lymphoma: A case report

Ma,

Chung,

Kim

et al. 2023

Medicine

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Rationale: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rare, but its incidence has recently increased. It is characterized by a sudden onset of seroma collection after implantation of textured breast implants. However, BIA-ALCL may be confused with late hematoma, which is also a rare finding in aesthetic breast surgery. The cause of late hematoma is mostly unknown, and patients rarely present with specific symptoms. Patient concerns: We presented a case of late hematoma that occurred in a patient who underwent augmentation mammoplasty 25 years ago and was on anticoagulants for 7 years. Diagnoses: Ultrasonography and magnetic resonance imaging could not rule out the possibility of BIA-ALCL. Interventions: Bilateral implant removal was performed, and massive amounts of late hematoma and organizing tissues were removed. Outcomes: The pathologists confirmed the biopsy results as late hematoma with organizing tissues. Capsules from both sides were confirmed as fibrous capsules with chronic inflammation and foamy macrophage infiltration. Lessons: Although malignancy needs to be primarily ruled out, late hematoma can occur beyond expectations, especially in anticoagulated patients, and must be included in the differential diagnosis.

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“…An implant-associated reactive inflammatory change is the main alternative diagnosis of BIA-ALCL since atypical-appearing macrophages, multinucleated giant cells, myofibroblasts, and immunoblasts are morphologic mimics of ALCL cells and are also present in an effusion and on the surface and within the fibrous capsule [ 173 ]. Pathologists should be aware that immunoblasts (B and T), plasma cells, and stromal cells can express CD30, but usually not at the level of intensity as seen in BIA-ALCL [ 174 ].…”

Section: Breast Implant-associated Alclmentioning

confidence: 99%

ALK-Negative Anaplastic Large Cell Lymphoma: Current Concepts and Molecular Pathogenesis of a Heterogeneous Group of Large T-Cell Lymphomas

Piña‐Oviedo

Ortíz-Hidalgo

Carballo-Zarate

et al. 2021

Cancers

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Anaplastic large cell lymphoma (ALCL) is a subtype of CD30+ large T-cell lymphoma (TCL) that comprises ~2% of all adult non-Hodgkin lymphomas. Based on the presence/absence of the rearrangement and expression of anaplastic lymphoma kinase (ALK), ALCL is divided into ALK+ and ALK-, and both differ clinically and prognostically. This review focuses on the historical points, clinical features, histopathology, differential diagnosis, and relevant cytogenetic and molecular alterations of ALK- ALCL and its subtypes: systemic, primary cutaneous (pc-ALCL), and breast implant-associated (BIA-ALCL). Recent studies have identified recurrent genetic alterations in this TCL. In systemic ALK- ALCL, rearrangements in DUSP22 and TP63 are detected in 30% and 8% of cases, respectively, while the remaining cases are negative for these rearrangements. A similar distribution of these rearrangements is seen in pc-ALCL, whereas none have been detected in BIA-ALCL. Additionally, systemic ALK- ALCL—apart from DUSP22-rearranged cases—harbors JAK1 and/or STAT3 mutations that result in the activation of the JAK/STAT signaling pathway. The JAK1/3 and STAT3 mutations have also been identified in BIA-ALCL but not in pc-ALCL. Although the pathogenesis of these alterations is not fully understood, most of them have prognostic value and open the door to the use of potential targeted therapies for this subtype of TCL.

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Silicone granuloma mimicking Breast Implant Associated Large Cell Lymphoma (BIA-ALCL): a case report

Cited by 6 publications

References 11 publications

The Value of Ultrasound in the Evaluation of the Integrity of Silicone Breast Implants

The Value of Ultrasound in the Evaluation of the Integrity of Silicone Breast Implants

Bilateral late hematomas after breast augmentation mimicking anaplastic large cell lymphoma: A case report

ALK-Negative Anaplastic Large Cell Lymphoma: Current Concepts and Molecular Pathogenesis of a Heterogeneous Group of Large T-Cell Lymphomas

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